Since 2002, the clinic run by the assisted dying organisation Dignitas in Switzerland has been chosen by more than 500 Britons to end their lives. Here we look at some of those Britons who made their final journey to the facility.
First UK citizens to die at Dignitas
In 2002, a 77-year-old man with terminal throat cancer became the first Briton to take his own life at the assisted suicide clinic in Switzerland.
The former docker Reg Crew was the first named British person to have publicly travelled to die at Dignitas, in January 2003. The 74-year-old had had motor neurone disease for more than four years.
Craig Ewert
A former university professor with motor neurone disease, Ewert, allowed his death at the clinic in 2006 to be filmed and later shown in Britain in a documentary. The 59-year-old American father of two, who had moved to the UK after taking early retirement, travelled there from his home in Harrogate, North Yorkshire.
‘Mrs Z’
The woman publicly referred to as “Mrs Z” was at the heart of a landmark court case to determine whether she could travel to Dignitas with the help of her husband of 45 years. The 66-year-old had an incurable brain condition called cerebellar ataxia.
In 2004, she went to the high court over attempts to prevent her from dying at Dignitas. Her local authority brought the case after learning of her plans.
A judge decided not to frustrate her wishes to die abroad and lifted a ban on her husband, also 66, taking her abroad, in the first case of its kind.
Mrs Z died in Zurich on 1 December 2004.
Daniel James
At 23, James, who had played rugby for England as a teenager, became the youngest Briton to die at the clinic in September 2008 after being paralysed from the chest down in a rugby training accident.
West Mercia police initially investigated his death but three months later the director of public prosecutions announced that no action would be taken against his parents as it was not in the public interest, “although there was sufficient evidence for a realistic prosecution”.
His parents said James, a tetraplegic, felt his body had become a prison and he lived in fear and loathing of his daily life. His death led to widespread debate as he did not have a life-threatening condition.
Sir Edward and Joan Downes
In 2009, one of Britain’s most respected conductors, Sir Edward Downes, and his wife, Joan, ended their lives together at the clinic. Edward, 85, who was knighted in 1991, was almost blind and Joan, 74, was his full-time carer. He had a long and distinguished career with the BBC Philharmonic and the Royal Opera House, and conducted the inaugural performance at Sydney Opera House. The couple’s children, Caractacus and Boudicca, said their parents had “died peacefully, and under circumstances of their own choosing”.
Robert and Jennifer Stokes
In 2003, Robert and Jennifer Stokes, from Leighton Buzzard, Bedfordshire, died in Switzerland after contacting Dignitas. Robert, 59, had epilepsy and Jennifer, 53, had diabetes and back problems. Both had depression but neither was terminally ill. Family members demanded that the clinic be closed down.
Peter and Penelope Duff
Peter and Penelope Duff were the first terminally ill British couple to have an assisted death in 2009. Before Christmas 2008, they invited guests for a drinks party in an elegant Georgian townhouse overlooking the city of Bath. Their guests did not know that both hosts – he was 80, and she was 70 – were terminally ill with cancer and that they were, in effect, saying goodbye. In February 2009 they died at the clinic.
Widowhood is hard to bear. It doesn’t matter how long you have been a couple, you are losing your “cellmate” and all those plans and hopes you had for the future. Your partner may well have been the only person you shared your innermost thoughts with. And they may have been the only one to tell you that you are beautiful or rather handsome.
The solitude of suddenly being on your own can be agonising. Even if the death was expected, there is nothing that can prepare us for the feeling of a sledgehammer shattering our heart.
Grief affects us physically, emotionally and spiritually, therefore it is important to safeguard your wellbeing during this time.
Allow yourself to feel the pain
Accept that you must grieve. There is no magic formula as each relationship is totally unique and, if you had a strained relationship, you may also have conflicting feelings which can be confusing.
“Accept that you must grieve. There is no magic formula”
It can be very isolating to discover that no one really knows or understands how you are really feeling, and seeing other couples can make your loneliness feel permanent. Give yourself permission to hurt.
Don’t isolate yourself
Find supportive people to go to for comfort. These are people you feel safe with who will let you sit with your sadness, who will be there with an open heart and allow you to wallow in your tears and not try and change how you feel.
Find a supportive network of people to help you through this time
Leave the radio on so that coming home is softened a little. Schedule calls or FaceTime with family friends as soon as you get home so an empty house is less daunting.
Don’t neglect your physical self
Grief work isn’t just emotional, it’s physical too. Take time to be active, whether this means continuing with a usual activity or just taking a walk outdoors.
Everything is disrupted—eating, sleeping, thinking—and through it all we are anchored in the unfairness of it all, so you may have to push yourself to keep active. Rest, eat well and be kind to yourself.
Plan ahead for difficult dates
You may dread the hurdle of your next wedding anniversary, Valentine’s Day, birthdays and special events. Plan ahead and plan well. Don’t let others railroad you into doing something you don’t want to do.
Remember how resilient you are
Identify those times in your life when you have shown strength and resilience in times of adversity and know that you have the power to weather the storm of your grief.
“Know that you have the power to weather the storm of your grief”
Grief takes us down and almost destroys us. It changes us but it also teaches us that we are stronger than we imagined. Don’t let it make you bitter. Let it make you kinder.
Let yourself have happy moments
Don’t berate yourself when you have your happy moments (which you will) —this is perfectly healthy and normal.
Let yourself find moments of happiness
Healing isn’t something that just happens, it is something you choose to believe. Don’t let your pain define you. If your sadness prevents you from being able to share all of the joy that your partner brought to your life, the legacy of love becomes lost, not only to others, but to you too. You have a duty to your partner and to those you love, to continue. As hard as this is, please respect this.
Take lessons from your loss—spend time with the people you love and make you feel good and tell them! Find the beauty in nature. Do things that make you happy and let go of the negative.
Understand that not everyone will understand
Some people may make comments like, “Don’t worry. You’re young enough to meet someone else.” Or, “At least you have the children.” Try to be forgiving of those who don’t know what to do or say and remember it is their intention to help and make a difference. They have no idea that their comments can cut so deeply. Try not to have expectations of others—they do not know how you are feeling.
Allow friendships to change whether by ending or by strengthening, and try not to take it personally if someone you thought was a friend disappears. Losing a partner is like dropping a pebble in a pond—everyone gets splashed.
Move at your own pace
Try not to let others tell you you’re moving too fast, or it’s been too long. Through your loss, you have learned the value of grabbing experiences and taking chances. Be and do you.
“The experience of grief is incredibly personal”
Do not be afraid to defend your choices. Usually, others are quick to judge when there are issues in their own lives. Don’t let what other people say stop you from living. We all know more than ever how fragile life can be and if you get the chance to love again, take it. Every love is totally unique. Love is not possession; it is the freedom to be you even though you are two.
The experience of grief is incredibly personal. Allow yourself to feel the pain, take care of yourself and share your lovely memories with others in your life. This helps to keep a closeness and connection to your partner.
Gallery: Cheryl Hauser smiles as she looks out the window Friday, Nov. 5, 2021 at her home in Hopkins, Minn. Hauser, who has Alzheimer’s disease, has decided to eventually hasten her death by voluntarily stopping eating and drinking after watching her brother die from it.
It’s not the dying I mind, Cheryl Hauser used to say.
It’s the leaving.
She left us this month. On her own terms, in her own time; surrounded by as much love, music and kindness in death as in life.
This is her parting gift to us. A chance to talk about the part of life nobody wants to think about.
The end.
“We would sing to her and rub her feet and her hands,” said Cheryl’s daughter, Wendy Longacre Brown, who chronicled those final days as her terminally ill mother voluntarily stopped eating and drinking to hasten the end.<
"You're in it together," said Brown, who has worked for years as a death doula, easing the transition from this life to whatever comes next. “There’s a lot of joy and laughter. But there is sadness.”
Cheryl had loved the life that Alzheimer’s was stealing from her.
“She was everything,” her daughter said. “She was someone who could sing in the grocery store aisle, then have a long conversation out in the parking lot with a total stranger.”
But Cheryl knew what was coming. She lost her brother Bill to Alzheimer’s, years before the disease actually killed him.
When she was diagnosed, she knew how she wanted her story to end. When the time came, she would VSED — voluntarily stop eating and drinking.
“When the day comes when nothing matters anymore, I’ll begin,” she told the Star Tribune in 2021. “My brother died of this disease and it was torture. I don’t want that for me and my family.”
Instead of languishing for years in memory care, she chose to spend her last weeks at home in Minnetonka. Friends visited, musicians serenaded her, and her grandchildren pressed her thumb into soft clay to create keepsakes. She sat outside in the sun, surrounded by summer flowers and birdsong.
One of Cheryl’s daughters is a birth doula. The other a death doula. Welcoming us into the world and helping us say goodbye.
“The more that death is part of the conversation and less of a taboo, the more we as a community can be present for one of the two most significant moments in your life,” Brown said. “It’s never too early to start a conversation of what people wish for around their end of life.”
Brown had helped other families through the goodbyes that nobody wants and everyone needs. Now she was the one saying goodbye. Every day, she shared photos and updates on her mother’s condition on cherylhauser.com.
The site started as a way to share news with family and friends. But it also drew strangers, who grieved with them and marveled at their generosity. In a culture that shies away from talk of death, here was a family showing us what dying looks like. Or what dying could look like.
“People often ask, did she have doubts? I can honestly say she did not,” said her husband, David McNally.
VSED is not a swift or simple death and patients in cognitive decline need special care to ensure that they are capable of giving informed consent. But this had always been Cheryl’s plan.
There were moments, as Cheryl was dying, when she would become confused and forget. Her family would sing to her, massage her legs as they cramped from dehydration, and offer her a tiny spritz of water or a cold spoon to hold in her mouth for comfort.
VSED cases are overseen by doctors and hospice staff. Caregivers were with Cheryl to make sure she was comfortable and had medicine to ease any pain or anxiety.
It was a death only possible in a family that talked about the end of life long before they needed to.
“Several times in the journey [in the four years between Cheryl’s diagnosis and death], I would say to her ‘How are you feeling about VSED?’ ” McNally said. “She would say no, I’m good, I’m going to do it. When my time comes, I will do it.”
The couple met when they were 60 and married when they were 70. Sixteen years. That’s all the time they were given. They made the most of their last four years together; traveling, going on adventures and advocating for the right to a dignified death.
Cheryl “was a very outgoing, very joyful person, just an extraordinary personality. She lit up a room,” he said. “She connected with people. She had this uncanny ability, when speaking with people, of making them feel special.”
There were incredibly sad moments, he said, as the disease progressed and her beautiful life started to slip away. Cheryl lost the ability to drive, to play the piano, sometimes she struggled to tell one grandchild from another. In the end, he said, she could do almost nothing for herself without help.
In May, she told her family she was ready.
Cheryl Harms Hauser, who had a smile that could light up a room, died on June 2, 2023. She was 76 years old.
When delving into the realm of funeral services, it becomes evident that the factors of perplexity and burstiness play a significant role in shaping the narrative and experience. Within the context of Buddhism, a unique approach emerges, characterized by a harmonious blend of complexity and variation. In this article, we embark on a journey through the intricacies of Buddhist funeral services, unraveling the distinct elements that make them truly exceptional.
Introduction to the Unique World of Buddhist Funeral Services
A Buddhist funeral service stands as a remarkable testament to honoring and commemorating the life of a departed loved one. Rooted in the profound principles of Buddhism, it weaves together solace and closure for those who embrace this philosophical path. The essence lies not only in bidding farewell but also in facilitating the departed’s transition to a new existence, while extending support and solace to family and friends. Brace yourself as we embark on an enlightening exploration of what unfolds during a Buddhist funeral services, replete with intriguing aspects that set it apart from other funerary rites.
Unraveling the Tapestry of a Buddhist Funeral Service
Buddhism, with its profound history spanning centuries, encompasses both life and death within its embrace. Consequently, it is no surprise that Buddhist funeral services occupy a pivotal role in the process of mourning, honoring the deceased, and offering solace to those in attendance.
The commencement of a Buddhist funeral ceremony often finds its roots in the enchanting chants emanating from sacred Buddhist scriptures. These mellifluous melodies intertwine with prayers, creating an ethereal ambiance of remembrance. Moreover, the ceremony may include the recitation of sutras, skillfully rendered by learned monks or devoted family members. The atmosphere is further enriched by the fragrant offerings of incense and flowers, as well as heartfelt eulogies delivered by kin or close confidants. Remarkably, depending on tradition, one may even encounter moments of serene meditation or other spiritual practices that infuse the service with an aura of profound contemplation.
Central to the fabric of a Buddhist funeral service is the paramount objective of assisting those present in embracing the concept of mortality and finding inner peace within its embrace. In the realm of Buddhism, death is not feared but rather acknowledged as an integral part of life’s cyclical nature. Thus, these solemn moments serve as an opportunity for friends and family to reflect on the impact of loss and to share treasured memories of the departed.
As the ceremony unfolds, the offering of food takes center stage, symbolizing the departed spirit’s passage into an alternate realm. These gestures of culinary homage vary in accordance with local customs, each carrying its own significance and depth of meaning.
Discovering the Meaningful Essence of a Buddhist Funeral Service
In the tapestry of existence, a Buddhist funeral service emerges as a poignant and meaningful tribute to those who have embarked on their final journey. Rooted in compassion and embracing the transient nature of life, this sacred rite serves as a conduit for honoring the spiritual odyssey of the departed while providing solace for those left behind.
At the heart of any Buddhist funeral service lies the mesmerizing art of chanting. Through the recitation of prayers and mantras, a profound reverence for the departed is awakened. Whether performed by family members or revered monks, these sacred utterances transport the mind into a realm where the fragility and vitality of life intertwine.
Equally significant is the act of honoring the deceased through symbolic offerings. Flowers, incense sticks, and favored fruits or food items find their place before an image or statue representing the three jewels of Buddhism: Buddha Shakyamuni, his teachings (Dharma), and the monastic community (Sangha).
— Meet the widows (and widowers) craving human touch
After the death of a partner, widows and widowers often face judgment when they’re ready to have sex again. Widow’s Fire, a new online community, is trying to help.
When Lori* started dating less than a year after her husband suddenly died, she knew some people would judge her.
And they did.
She recalled the reactions: “Whoa, why isn’t she grieving longer? Did she even really love her husband?”
Lori didn’t allow the judgment to faze her. She filled out an online dating profile and started meeting men.
“I needed to be distracted,” she said. “I dated different guys, but I didn’t get serious about anyone and I wasn’t intimate with them. It was just really nice to have some touch, like holding hands — even having someone show me attention. I missed that.”
Julia*, the founder and host of Widow’s Fire, an online community for people who have lost their life partners, said that many of her members make similar comments about their motivation for joining the site for “heartbroken but hopeful” widows and widowers.
“A new member wrote me just this morning and said, ‘I miss the closeness of another body, not necessarily the sex act itself,’” said Julia.
She noted, though, that there are also plenty of Widow’s Fire members who joined the community because they simply miss sex.
Five years ago, when she was 31, Julia’s husband died. That’s when she first heard the term “widow’s fire,” which is defined by the community as “a burning desire for sex following bereavement of a spouse or partner.”
“When friends and family asked how I was doing, I would say ‘I’m OK’ or ‘I’m struggling,’ but what I was actually thinking most of the time was, ‘I miss sex,’ ‘I wish I could have sex’ or ‘When will someone ever touch me again?’” said Julia. “It was all-consuming. I thought sex would be like medicine if I could get my hands on it.”
Julia said there was a decent level of support for her as a grieving widow and a parent of a newborn, but there was a dearth of resources when it came to bereavement sex.
And, like Lori, she felt she was being judged for wanting it.
“I had someone say to me, ‘Don’t you want to wait a couple of years?’” she said. “And I thought, ‘How lovely for you to be able to sit there and say that to me and then go on with their day.’”
Dionne Gesink, a professor with the Dalla Lana School of Public Health at the University of Toronto, said the experience of grief is highly individual. For some people, bereavement has no effect on their sex drive; for others, it can decrease it. For others still, it will increase it, sometimes dramatically.
“Partly that’s because, with sex, you get an increased sense of power and control,” said Gesink, who also researches sexual health. “It’s a way to get back into your body and to get access to great hormones like endorphins, dopamine and oxytocin, which make you feel better, block pain, decrease stress and improve your mood.”
And, Gesink added, human connection can help you feel less disconnected, a common problem for people grieving a loss.
“Loneliness is kryptonite for the widowed in general because, not unlike teenagers and retirees, we need meaning and purpose to move forward,” said Andrew*, a 42-year-old father and widower in Toronto who joined the Widow’s Fire community two years ago.
He added, however, that his interactions with others he has met on social media and through Widow’s Fire have led him to believe that sex alone doesn’t bring most people much long-term relief.
“I find value in my faith and my child along with our family and friends,” he said.
That tracks with Gesink’s research on sexual health. Touch is essential for human existence, which is part of the reason the loss of an intimate partner can be so devastating. Sex can alleviate some of the suffering but, when it comes to healing, it can only get you so far.
That doesn’t mean that sex can’t play a role, of course. Some people have a harder time than others being alone, so everyone’s journey will be different. Gesink said it’s important that friends and family stay “flexible” in their thinking about moving on after bereavement.
“Anyone going through that kind of grief should just try to be kind to themselves and to give themselves permission to explore different ways of connecting to others,” said Gesink.
“You shouldn’t have to carry guilt around for that.”
— Actors on the toll of dying on stage night after night
Going, going, gone … Nato Murvanidze as Cordelia in a 1996 King Lear.
What’s it like to expire every evening, often in devastating, drawn-out scenes? Nathan Lane, Josette Simon and more talk about how playing death messes with their minds – and describe the ‘de-role’ rituals that bring them back
Death is an act most of us will perform only once. But for actors, it can be a regular occurrence. On stage, their character’s demise may come with a sudden gunshot or be devastatingly drawn out and come with a rousing speech. But how does it feel to die night after night after night in such roles?
In the National Theatre’s 2017 production of Tony Kushner’s Angels in America, Nathan Lane played Roy Cohn, the real-life political fixer who denied his diagnosis of Aids until the very end. “He thinks he’s indestructible,” says Lane, who faced a double challenge. In the play, Cohn attempts to get the last laugh by faking his own death, before the real one comes along. Lane was required to lie in a hospital bed on stage. “I pulled out an IV,” he recalls, “and this blood would spurt out. And I had to have these body tremors. It has an effect on you psychologically. There’s something about lying in a hospital bed and gown. You do start to feel sick.”
Playing Richard III for the Royal Shakespeare Company last year, Arthur Hughes found himself hyperventilating from the “headrush” of his death scene, surrounded by the ghosts of men he has murdered. “The end is a real acceleration,” Hughes says. “I was barefoot, covered in armour, ranting, raving, running, fighting. It ratchets up and up until he’s dead – and then it just stops.”
Later, the play’s abrupt ending would catch up with him. “Some nights we’d go to the Dirty Duck, the pub over the road, and I’d be like, ‘God, I really need a pint after that.’ But I soon found out that wasn’t the thing to do.” His head was too noisy. “I’d never played a character where I needed to ‘de-role’ before, but I had to create a ritual to take it all off.” He would sit on a cushion repeating gentle mantras to himself, shedding the angst that builds to Richard’s death. “I just needed some stillness. I found that if I didn’t do that, I wouldn’t sleep well.”
‘You do start to feel sick’ … Nathan Lane as Roy Cohn and Nathan Stewart-Jarrett as Belize in Angels in America.
Patrick Vaill has been dying nightly, on and off, for 16 years. Death haunts Jud Fry, the lonesome outsider he plays in Daniel Fish’s illuminating revival of Oklahoma!, currently playing in London’s West End. It’s a role Vaill first took in 2007 at college. In one scene, Curly taunts him with the idea that, in death, Jud will have what he has always wanted: to be loved. “Death is presented to him almost in a romantic way,” Vaill explains. “It comes as a sort of softening.” When death finally arrives, it is staged somewhat abstractly. “We don’t do a literal, ‘I’m dying, I’m bleeding, slow collapse.’ What we shoot for is the emotional reality, the intellectual reality.” Once on the floor, he lets his body relax. “It’s an almost meditative moment of taking care of yourself, which is oddly similar to what death is presented as, to Jud.”
The sense of peace doesn’t last long. “Halfway through the Broadway run, I started to feel the weight of doing this every single day,” says Vaill. “Everything was tight, so I talked to a physical therapist.” The physio made a clear connection between the emotional performance and the physical consequences. “I was reminded by this doctor that, yes, your brain knows that this is fake, you’re not dead, this is your job, this is a story. However, your body hears a bang every night; your body is crying; your body is simulating fear.”
Can it be that in an intensive performance of death, the body starts to believe it’s real? Like Hughes, Vaill had to find ways of coping. He showers straight after the show. “First of all,” he laughs, “it washes off the blood. But a hot shower reminds your body: this is fake, these are your friends, you love doing this, and at the end of the day, you’re playing.”
‘Eight deaths a week for months and months’ … Patrick Vaill in Oklahoma! at the Young Vic, London.
Theatre may be an ephemeral art form but the physical and mental repercussions of performing over a long period can last. If you were doing the same performance for a film or a TV programme, says Vaill, you could “wreck yourself”, but that simply isn’t possible in theatre. “You have to do it eight times a week, hopefully for months and months.” As a result, you can’t let the intensity of it all affect your home life. The aftercare of performance is critical, he says, to reassure your mind and body that you are safe. “That kind of stuff becomes as important as doing your vocal warm-up before the show.”
For Josette Simon, getting into the role of Cleopatra at the RSC in 2017 was a far longer and more involved process than getting out of it: she found her mindset would change daily at around 3pm. Cleopatra takes her own life with a poisonous asp. “She’s right in the middle of the line,” Simon says. “So I thought she should die with her eyes open.”
Doing so upright in her throne, directly facing the audience, was not the easiest dramatic choice. “I made a rod for my own back,” she admits, “because I then had to spend the whole of Charmian’s speech with my eyes open, not blinking.” In rehearsal, her eyes would start streaming in seconds. “But I trained the muscles around my eyes. Every day, I would sit incrementally longer with my eyes like that. Occasionally in production I would feel a tear coming and I’d think, ‘Come on Charmian, get on with the speech!’” Today, Simon says with a sly smile, she believes she could still win any staring contest. “I’ve got it down to a fine art.”
Describing the way she would get into the character, Simon sees no separation between herself and the role. But in that moment of death, when there are no more thoughts in the character’s head for her to imagine, she would drift back to herself. She found it vaguely meditative, focusing on her breathing after the storm she had just delivered. “I was usually quite tired by this point, too,” she laughs. “It’s three hours and 15 minutes on the stage with extremely long speeches.” Unlike Vaill and Hughes, Simon didn’t have a nightly ritual to shake off the part and her death. For her, she says, “the character ends at the curtain call. It’s the end of that page and every night is a new page, as if you’ve never done it before.”
‘I could win any staring contest’ … Josette Simon as Cleopatra in Antony and Cleopatra in 2017.
Although Simon would like to think a theatrical performance engaged with death might spark meaningful conversations off stage, she doesn’t really believe this happened. “We as a culture are terrible at talking about death,” she says. “We can’t even say the word. We can’t take the terror out of it.”
This fear of death took centre stage in Victoria Melody’s 2017 show Ugly Chief. When Melody’s father, Mike, was misdiagnosed with a terminal illness, he asked her to organise his funeral. She went one step further and trained to become a funeral director. Together they turned the surreal experience of planning your own sendoff into an anarchic show that aimed to open up a conversation about death. Indeed, a funeral “is like a sad theatre show”, Melody says. “A lot of pomp and creativity goes into making it a dramatic experience.”
In making the show together, they dug up topics they had avoided for years. He scrapped the initial eulogy she wrote for him because it made him into a saint, when in fact he’d been, she realised, a “chain-smoking, angry, depressed man who played Football Manager all day, so I left home at 16”. Instead, they wrote his eulogy together.
‘I think it made him want to live longer’ … Victoria Melody with her father Mike in Ugly Chief.
“We had people write to us after the show,” Melody remembers. “We had a dad who said it made him get in touch with his estranged son and mend their relationship, and we had an email from the son saying thank you.” The act of creating the show was transformational for her own dad, too. “He’d been an alcoholic my whole life,” she says matter-of-factly. “After that tour, he stopped drinking. I don’t think it changed his attitude to death, but I do think it made him want to live longer.”
On Broadway, Nathan Lane recently performed opposite Zoë Wanamaker in Pictures from Home, a play based on photographer Larry Sultan’s moving book about his ageing parents. Does taking part in another show about grief make Lane think more about his own mortality? “Sure,” he shrugs, “but I don’t need a play to do that. I think about death all the time. The more you see contemporaries die, you really think, boy, you just have to appreciate every moment.” He points to one of Wanamaker’s lines in Pictures from Home: “Of course I’m terrified of it, but we’re all going to die. Hopefully, you do it well.”
When sheriff’s deputies in Florida went to perform a welfare check last month on Tori Bowie, the Olympic runner, they made the saddest possible discovery. Bowie and her newborn daughter were dead. Though the full story of Bowie’s last days has yet to emerge, some details are clear: She had died in labor, suffering from eclampsia and respiratory distress.
Expectant moms deserve more from their lawmakers, providers, public health groups and hospitals: more visits before and after pregnancy, better access to the simple drugs and devices that could keep them alive, and expanded insurance coverage.
Since the federal government began keeping records in 1987, America’s maternal mortality rate has only gotten worse. Between 2000 and 2020, the United States was one of eight countries where the situation deteriorated fastest, a list that included Venezuela and Mauritius. There’s no one cause of this long slide: A strained health-care system, a stingy insurance system, a lack of paid leave, the retreat of reproductive rights and endemic racism all contribute.
Covid-19 made a bad situation worse. Pregnant women who contracted the virus were seven times more likely to die than those who avoided infection. But even as vaccination became widespread, pregnant women kept dying from all the more common causes: infections, hemorrhages, hypertensive disorders such as preeclampsia and embolisms. In 2022, 733 American women died while pregnant or shortly after childbirth. That’s a maternal death rate of 20 per 100,000 births — up from 17.6 in 2019, already two or three times the rate of many high-income nations.
For Black women, pregnancy and childbirth bring the toll of racism in the United States into sharp focus. A large body of research shows that being Black in America wears on women’s bodies, leaving them uniquely vulnerable during pregnancy. Black women are 60 percent more likely than White women to experience preeclampsia, for instance. Add to which they experience inequalities in access, quality of care, prescribing, data collection and more. These differences persist even among wealthy, educated women. So stark is the disparity it has come under United Nations scrutiny.
There’s much providers can do to help: A 2019 analysis of preventable maternal deaths by the Centers for Disease Control and Prevention gives a clear list. Open earlier or stay open later to serve patients who work nights. Accept Medicaid. Educate patients early and often about conditions to watch out for. Take patients with headaches or shortness of breath seriously.
And there’s a lot policymakers must do to keep pregnant women safe and healthy. Fortunately, even in this divided, fractious Congress, there’s bipartisan support. Bills introduced by Reps. Lauren Underwood (D-Ill.), Robin L. Kelly (D-Ill.) and Robert E. Latta (R-Ohio) and Sens. Charles E. Grassley (R-Iowa) and Maggie Hassan Wood (D-N.H.) would pull together working groups to identify the best ways forward. One target of Kelly and Latta’s: Finding ways to identify and improve hospitals and doctors who are failing women and babies.
Lawmakers in both parties agree that childbirth and postpartum support from other practitioners matters, too. Evidence is accumulating that access to doula care during labor can lower Caesarean section rates. Doulas offer mothers nonmedical support and advocacy before, during and after delivery. Programs run both by community groups and insurance giants are exploring whether doulas can have a measurable impact on maternal mortality, especially for Black women.
Congress funded some home health visiting programs in the 2022 government appropriations bill. The United States should join other wealthy countries in making sure new mothers get regular visits after they come home from the hospital, when they are still at risk.
It would also help to standardize how Medicaid covers the medicines and devices for pregnant people. An analysis by KFF found glaring gaps. Four state Medicaid programs still don’t cover low-dose aspirin, which can prevent preeclampsia. Ten don’t cover blood pressure monitors for use at home between doctor’s visits. And six states don’t cover glucose monitors, crucial for managing gestational diabetes.
Meanwhile, the federal government could kick-start pilot programs that explore new ways to lower maternal mortality. Examples include payment schemes that compensate providers who do a better job for mothers and babies or demonstration projects that bundle housing and prenatal care in the same setting.
We don’t know whether Tori Bowie and her baby could have been saved with earlier intervention. We do know how to save hundreds of other American mothers.
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